Wales's Individual Health Record system makes medical notes available wherever they are needed. Photograph: Brooklyn Production/Corbis

In an echo of his predecessor John F Kennedy, Barack Obama has set his nation a massive technological challenge. In his first weekly presidential broadcast, he pledged: "We'll computerise the nation's health record in five years, saving billions of dollars and countless lives."

Compared with Kennedy's 1961 ambition to send a man to the moon "before the decade is out", the goal of computerising health data may seem unheroic. However, in many ways it is a more daunting challenge. The moon programme was a triumph of human endeavour, but it was based on rock-solid principles: in 1961, scientists knew exactly where the moon would be nine years hence and roughly how they would go about getting there.

Moving target

Experts planning the computerised health record enjoy no such certainty. The "nation's health record" does not even exist as an entity today and it would be foolhardy to predict what it will look like in five years' time.

For a lesson in how to manage the programme, Obama might do well to look across the Atlantic. Not to the NHS in England, where a £13bn-programme is this year reeling from its latest parliamentary battering, but to Wales.

Earlier this month, Edwina Hart, the Welsh assembly's health minister, approved a plan to extend a system called the Individual Health Record (IHR) across the country. The decision comes seven years after the equivalent announcement in England, but no one need apologise for the delay. The Welsh IT team says that, by eschewing political deadlines and working with the NHS rather than trying to impose technology, it has created an electronic medical record that is not only more useful than its English equivalent but will cost a fraction of the price.

The secret, says Gwyn Thomas, chief executive of the agency Informing Healthcare, is to listen to users.

The contrast with the gung-ho English programme, now enervated by contractual rows and political grandstanding, is graphic. In the latest report, the chairman of the Commons public accounts committee, Edward Leigh MP, said: "Essential systems are late, or, when deployed, do not meet expectations of clinical staff; estimates of local costs are still unreliable; and many NHS staff remain unenthusiastic."

Wales and England started off with the same goal - to make computerised medical records available where they are needed. However, the two countries went about it in wildly different ways.

In England, the NHS took it for granted that the right technology was available and that staff were enthusiastic about adopting it. The central challenge was seen to be procuring the technology on the best terms, and implementing it to timetable. This involved a series of billion-pound contracts to provide central services and to rip and replace hospital systems across five regions created solely for the IT programme. Tellingly, one of the programme's explicit aims was to double the proportion of the NHS budget spent on IT. In Wales, by contrast, there were no big procurements and virtually no new money. When Thomas took up his role in 2005, he decided to work with existing technology to make information available where doctors needed it. Everything would move incrementally, with the consent of all concerned.

This involved several radical departures. In England, a central "spine" is designed to carry a summary record of every patient. The Welsh IHR draws data directly from GP records, with sensitive data such as terminations removed. Patients are asked for consent every time their record is viewed - unlike in England, which initally assumed patients to have given consent unless they explicitly opted out.

Patient approach

The IHR was first tested at doctors' out-of-hours services in one county, Gwent, and then at one hospital, Royal Gwent. Crossing the gulf between GP and hospital is itself a breakthrough for NHS computing. It was made possible by technology from a specialist firm, Graphnet, which, because of its small size, was not eligible for any of the big English contracts.

All this happened at a glacial pace - which, Thomas says, is a strength, not a weakness. "It gives us more opportunities to engage the users in testing. We've learned a huge amount about information governance, consent, patient safety."

The next stage will be to place a contract for the software and support. Thomas says he is "agnostic" about the type of firm he wants to hire. However the available budget - £4.7m - would be chicken feed to the big firms that fell over themselves for the English contracts.

It would be simplistic to present the Welsh and English stories as a straightforward Welsh triumph. The English programme has notched up some firsts, notably universal electronic x-ray images. It has also had to tackle political challenges such as the "choose and book" scheme, which was never on the agenda in Wales.